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Archive for the ‘eyelid lift’ Category

Lower Blepharoplasty for Fat Injection Removal

Wednesday, September 7th, 2016

 

Treatment of tear trough and under eye hollows has been revolutionized by the use of injection materials. Using either resorbable injectable fillers or fat taken from the patient, injection under the eyes can fill out sunken areas creating a rejuvenated appearance. Although there are advocates for either synthetic fillers and fat, both materials can have good success in the lower periorbital region.

While many patients have good improvement in their tear troughs and under eye hollows with injections, not all patients do. The under eye area is the most technique sensitive area of the face for any type of injection. The thin tissues of the lower eyelid reveal any asymmetries and irregularities of the injected material. This may not be apparent for several days or weeks when any swelling has subsided. In some cases too much volume ends up creating the appearance of lower eyelid ‘bags’ which the patient is swelling and will go away on its own.

Solving these lower eyelid injection materials is fairly straightforward with hyaluronic-based injectable fillers. Enzymatic digestion with hyaluronidase injections can rapidly remove any excess material. But this is not the case with other types of injectable fillers (e.g. Radiesse) and fat injections for which no reversal injections exist.

lower-blepharoplasty-for-injected-fat-removal-dr-barry-eppley-indianapolislower-blepharoplasty-injected-fat-extraction-dr-barry-eppley-indianapolisSuch materials can only be removed by direct excision through an open eyelid approach. By exposing the deeper eyelid tissues under the skin any problematic material, such as fat, can be directly removed. Injected fat looks different than lower eyelid compartmental fat and is fairly easily identified by its linear horizontal orientation. It can be carefully lifted out from the tissues in which it is embedded.

For those patients so afflicted with undereye contour problems from injected fat or particulated synthetic fillers, excision is the only effective treatment. Like all lower blepharoplasty procedures the subciliary and lateral canthal incision usually heal in an inconspicuous fashion.

Dr. Barry Eppley

Indianapolis, Indiana

Lateral Eye Lengthening Canthoplasty

Thursday, August 4th, 2016

 

In Asians double eyelid surgery is extremely common. It is also frequently done in conjunction with medial epicanthoplasty to eliminate the webbing of skin across the inner aperture of the eye. (epicanthal fold) But because many Asian eyes have a short horizontal length from the inner to outer eye corners, extending out the lateral length of the corner of the eye through lateral canthoplasty procedures is also done.

Unlike the medial epicanthoplasty, which does not really touch the inner corner of the eye, efforts at lateral canthoplasty do. Thus they have a higher rate of potential complications that involve separation of lid contact with the eyeball. (e.g. lid margin eversion, webbing) These risks are increased when the horizontal eye length is very short or has a high upturned out corner of the eye.

Lateral Canthal LengtheningIn the July 2016 issue of the Archives of Plastic Surgery, an article was published entitiled ‘Effective Lateral Canthal Lengthening with Triangular Rotation Flap’. In this paper, the authors describe a lateral canthal lengthening procedure that us both effective and has a very low rate of complications. In this technique a triangular flap 4mm or so away from the lateral canthus was incised and rotated 45 degrees laterally maintaining the continuity of the lower eyelid gray line. A new lateral canthus was created by suturing the rotation flap to the lateral orbital rim maintaining a triangular shape. The procedure was judged successful in 95% of the patients with visible lateral extension. The continuity of the gray line on the lower lid was maintained with a natural-looking triangular shape. The average amount of lateral extension was 3mms. Some minor complications did occur, such as wound dehiscence, webbing, and scarring, but these were stated to be easily corrected.which were easily corrected.

This lateral canthal lengthening technique uses a triangular flap that rotates 45 degrees out laterally to create its effect. Its simplicity avoids most complications and does not need to have a canthotomy to exhibit its effects.

Dr. Barry Eppley

Indianapolis, Indiana

Case Study – Upper Eyelid Lifts under Local Anesthesia

Tuesday, August 25th, 2015

 

Background: Upper blepharoplasty surgery, more commonly known as an eyelid lift, is the most common cosmetic eyelid surgery. It is tremendously effective and is associated with a very low risk of complications. While eyelid tissue is very thin and swells significantly after surgical manipulation, the recovery is fairly quick. The results of blepharoplasty surgery is sustained for years although its results are not permanent.

Blepharoplasty surgery is commonly done as part of other aesthetic facial surgeries such as facelifts and browlifts. As a result the swelling and bruising is seen as significant in the context of the overall face and the recovery is comparatively prolonged. But this composite facial rejuvenative surgery belies the otherwise relative ‘simplicity’ of the upper blepharoplasty procedure.

The upper blepharoplasty procedure relies on skin and some orbicularis muscle removal to create its effect. There is a debate as to whether any muscle should be removed along with the skin removal and its effect is primarily believed to help redefine the upper eyelid crease. Proper marking and not excessive tissue removal are the keys to an uncomplicated and satisfactory upper eyelid lift.

Because the upper eyelid is a small structure with thin tissues it can be fairly easily anesthetized by local anesthesia injections. Since the surgery can be done with the surgeon standing above or to the side of the patient and with the upper eyelid closed, the surgery can be performed out of the patient’s field of vision. This further promotes patient comfort.

Case Study: This 42 year old female felt her upper eyes were getting tired and heavy. She felt she had developed some hooding of skin that no amount of eyelid creams or Botox injections around the eyelids could solve.

Upper Blepharoplasty (Eyelid Lifts) under Local Anesthesia Dr Barry Eppley IndianapolisUnder local anesthesia injections into the upper eyelids, a tapering 7mm crescent of skin and muscle was removed along presurgical markings made with a caliper. The tissue segments were removed by scissors which minimized any bleeding. Small dissolveable sutures were used to close.

Upper Blepharoplasty (Eyelid Lifts) under Local Anesthesia oblique view Dr Barry Eppley IndianapolisUpper Blepharoplasty (Eyelid Lifts) under Local Anesthesia side view Dr Barry Eppley IndianapolisWithin one week after surgery she looked essentially no-surgical and had no bruising. Most of her upper eyelid swelling was gone by ten days after surgery. She described the experience as relatively painless and had no discomfort during the procedure and even afterwards.

An isolated upper blepharoplasty can be comfortably and safely performed under local anesthesia in the office. Its effects are immediate and the recovery is very short. Such an office procedure provides the most economic approach to having an upper eyelid lift done.

Highlights:

1) The upper blepharoplasties (eyelid lift) improves upper eyelid shape by removing hooding and redefining the upper eyelid crease.

2) An isolated upper blepharoplasty can be safely and comfortably performed under local anesthesia as an office procedure.

3) An upper blepharoplasty has a quick recovery with only moderate swelling and bruising.

Dr. Barry Eppley

Indianapolis, Indiana

Case Study – Z-plasty for Eyebrow Lowering

Sunday, June 28th, 2015

 

Background:The eyebrows provide an important framing structure for the eye area. Residing over the brow bones (supraorbital rims) their hairy composition provide an instantly recognizeable facial feature. While eyebrows have very variable shapes and hair features, and they are subject to considerable grooming and modifications based on contemporary style, the one consistent and important feature of them is symmetry.

Asymmetry of the eyebrows is a very noticeable facial feature. Even the slightest amount of eyebrow asymmetry can be detected.  It has been shown that as little as 2mms of difference in eyebrow position is noticeable to patients. While some degree of slight eyebrow asymmetry is present in many patients who present for periorbital rejuvenation for example, they can be very effectively treated by Botox injections for improved symmetry and less eyebrow movement. This works because the eyebrows are dynamic and have muscles that can be temporarily blocked or inhibited from moving.

But eyebrow asymmetry that results from nerve paralysis poses a much more challenging problem. The paralyzed eye brow is a fixed structure that is elevated rather than depressed. It can not be made to drop down by Botox injections nor can a surgical release  like in a browlift made it become lower. Eyebrow asymmetry from a lower then normal brow position is a much easier to improve as the eyebrow can be raised by a variety of browlifting techniques.

Case Study: This 19 year-old male had surgery as a young child to treat a large forehead lymphangioma. While the lymphangioma was cured, the resective surgery left him with a permanent paralysis of the frontal branch of the facial nerve. This caused the eyebrow to be permanently elevated. The forehead tissues were very scarred and immobile from the prior surgeries.

Eyebrow Z-plasty Dr Barry Eppley Indianapolisz-plastyUnder general anesthesia, his left eyebrow was repositioned lower using a classic z-plasty  tissue rearrangement technique. The entire tail of the eyebrow was lowered by switching the skin and deeper tissues below it and changing places with it.

Left Eyelid Reconstruction with Transposition Flap Dr Barry Eppley IndianapolisEyebrow Transposition Flap Dr Barry Eppley IndianapolisAt three months after surgery all skin flaps were healed. No loss of amy of the tips of the skin flaps occurred. The eyebrow position was much more symmetrical to the other side albeit not perfectly symmetric.

The overelevated or paralyzed eyebrow is a difficult challenge to reposition as all conventional methods of eyebrow repositioning rely on normal muscle movements and supple forehead tissues. A z-plasty method of reconstruction provides a simple and effective method of eyebrow lowering if the patient is scar tolerant.

Highlights:

1) Symmetry of the eyebrows is an important aesthetic facial feature.

2) An eyebrow that is too high is a much more difficult reconstructive challenge than an eyebrow that is too low.

3) The tail of the eyebrow can be lowered by a traditional z-plasty tissue rearrangement technique.

Dr. Barry Eppley

Indianapolis, Indiana

Medial Epicanthoplasty Techniques Compared

Sunday, June 21st, 2015

 

epicanthal fold dr barry eppley indianapolisThe Asian eyelid is known to have a lack of a supratarsal fold and the presence of an epicanthal fold. These are unique eyelid features which are the complete opposite eyelid features seen in the non-Asian eyelid. These differences drive some Asians to seek cosmetic improvement through double eyelid surgery and in the inner eye area. Decreasing the prominence of the epicanthal fold, known as a medial epicanthoplasty, has been described by numerous methods. No single epicanthoplasty technique has been determined to be the best although many surgeons clearly have their favorite technique.

In the July 2015 issue of the Plastic Reconstructive and Aesthetic Surgery Journal, the paper ‘Structural and cosmetic outcomes of medial epicanthoplasty: An outcome study of three different techniques’ was published. In this clinical study the authors evaluated the cosmetic outcomes from three different methods of medial epicanthoplasty. (root z-plasty, Y-V plasty and Mustarde’s technique. Studying 46 patients (92 eyes) over three years the change in horizontal fissure width were measured in terms of appearance, symmetry and scarring up to six months after surgery. Root Z-plasty, Y-V plasty, and Mustarde’s method were performed on 64, 13, and 15 eyes respectively. By six months after surgery, the horizontal fissure width increased by an average of 1.74 mm (8 % increase), 1.64 mm (9% increase), and 1.89mm (13% increase), respectively. Root Z-plasty had the higher postoperative appearance grade than the other two methods with the best scar appearance. Symmetry was good for all three methods.

epicanthoplastyAll studied medial epicanthoplasty techniques were able to increase horizontal fissure width. Collectively they did so by just under 2mms. It is interesting that such a small increase in horizontal fissure distance can make such a significant cosmetic improvement.The one distinguishing difference was that the root Z-plasty resulted in the best scar outcomes. Root Z-epicanthoplasty requires a fairly simple design and procedure to perform. It also creates the least amount of incisional lengths which may account for its best scar appearance.

Despite the incredibly small size of the epicanthal fold, reducing its appearance is challenging. It is an eye area that is both highly visible and creates a distinct appearance between the nose and eye. Every epicanthoplasty technique uses very small skin flaps but the risk of overcorrection and hypertrophic and visible scarring is real. It is a procedure that is truly defined by the phrase ‘less is more’ with emphasis on a conservative vs an aggressive approach.

Dr. Barry Eppley

Indianapolis, Indiana

Cooling Gel Masks After Blepharoplasty (Eyelid) Surgery

Friday, January 30th, 2015

 

The eyelids are very thin tissues that are well known to swell and bruise easily. Because one’s eyes are so visible, every upper eyelid surgery patient would like their bruising and swelling to go away as soon as possible. For this reason, it is standard practice to do several after surgery strategies including cold compresses, head elevation and the oral intake of Arnica. While no one after surgery strategy is known to be universally effective, it is commonly believed that cooling or cold would be the most important.

Eye Masks for Blepharoplasty Surgery Dr Barry Eppley IndianapolisThe use of eye cooling has led to a wide variety of gel compresses for the eyes for blepharoplasty patients. Most are composed of a gel material that retains cold for a period of time after being removed from the refrigerator or freezer. The historic cooling regime was frozen vegetables (such as peas or corn) but gel pads are lighter and easier to use

In the February 2015 issue of the journal Plastic and Reconstructive Surgery, a paper entitled ‘The Effect of Eyelid Cooling on Pain, Edema, Erythema, and Hematoma after Upper Blepharoplasty: A Randomized, Controlled, Observer-Blinded Evaluation Study’ was published. In 38 consecutive patients who had upper blepharoplasties performed, one side was cooled with an ice pack and the other eyelid was left uncooled. Evaluations were done on the degree of pain, edema, erythema, and occurrence of hematoma one hour, one day, one week, and two months after surgery. Light photography was used one week after surgery to determine the degree of bruising.

The results showed showed no difference in pain between the cooled and uncooled eyelids on the day of surgery. Pain in the cooled eyelids was significantly lower one day after surgery. No differences were seen in swelling, bruising or occurrence of hematoma between the cooled and uncooled eyelids at any time point in the study. The authors conclude that because the majority of patients had no preference for cooling over noncooling, eyelid cooling after upper blepharoplasty is not necessary.

Upper Blepharoplasty Indianapolis Dr Barry EppleyThis study casts doubt on a very long-held and logical treatment after upper blepharoplasty surgery. It just seems so logical that cooling/cold therapy would be beneficial that it is hard to believe that it isn’t. Despite what this study shows I doubt few plastic surgeons will abandon it. Particularly since it is a very low cost treatment that at the least has psychological value for the patient.

Dr. Barry Eppley

Indianapolis, Indiana

Plastic Surgery Case Study: Visual Obstruction Treated By Browlift And Blepharoplasties

Monday, December 8th, 2014

 

Background: Changes around the eyes are the earliest signs of facial aging. As a result, the ongoing aging effects often creates severe changes around the eyes as one enters their sixties. Besides the excess skin of the upper eyelids and the lower eyelid bags, the eyebrows often sag downward magnifying the hooding effect on the upper eyelids.

Visual Field testing Indianapolis Dr Barry EppleyHooding of upper eyelid skin and brow sagging do have functional effects. By weighing down the upper eyelids there is a loss of a portion of one’s visual fields. A portion or all of the upper visual field may be lost as the position of the upper eyelid acts like a blind over a window. Partial closure of the blind results in loss of one’s ability to see what lies above as one is looking straight forward. This is often confirmed by an historic test known as Goldman’s visual field examination which evaluates the entire range of peripheral vision. But automated perimetry testing today has replaced the traditional Goldman method in many ophthalmology/optometry practices.

To correct these severe eye aging effects and to improve one’s upper peripheral vision, multiple procedures need to be done. With brow sagging, an upper blepharoplasty alone (while helpful) may induce one to remove too much upper eyelid skin and severely shorten the distance between the eyebrow and the lashline. (in essence even pulling the eyebrow down further) A browlift combined with an upper blepharoplasty is needed to not only lift up the low brows but to also reduce the amount of upper eyelid skin that really needs to be removed. Together they create a periorbital effect that is better than a browlift or an upper blepharoplasty alone.

Case Study: This 62 year-old female was bothered by the way her eyes looked and how ‘old’ her appearance. She had such severe hooding that her upper eyelid skin hung below her lashlines. The weight of her upper eyelids, combined with some brow sagging, created a pseudo ptosis look as the level of her upper eyelids enchroached on the iros of the eye.

Visual Field Obstruction Blepharoplasties result front viewVisual Field Obstruction Browlift Blepharoplasties result oblique view Dr Barry Eppley IndianapolisUnder general anesthesia, an initial browlift was performed using a pretrichial incisional approach. An irregular zigzag incision was used along her frontal hairline. A total of 8mms of vertical upper forehead skin was removed for a moderate browlift effect. An upper blepharoplasty was then done using marks done before surgery based on pulling the brows upward. Lastly, lower blepharoplasties were performed with skin and fat removal, orbicularis muscle resuspension and lateral canthopexies.

Visual Field Obstruction Blepharoplasties result side viewHer results at six weeks after surgery showed a significant improvement in the appearance of her eyes but without an overdone look. Her lower eyelids had good contact with the globe and the position of the outer corner of her eyes was maintained. She did have some mild dry eye symptoms during the first month after surgery even though she had no ectropion or eyelid malpositioning problems. This is not rare when upper and lower blepharoplasties are combined with a browlift as this will slow the blink reflex for a period of time after surgery.

Case Highlights:

1) Severe aging around the eyes results in brow sagging and upper eyelid hooding which does impact one’s superior visual fields.

2) Optimal correction of visual field obstruction requires a combined brow lift and upper blepharoplasties.

3) Lower blepharoplasties are often done at the same time to enhance the overall periorbital aesthetic effect but do not provide an improvement in peripheral vision.

Dr. Barry Eppley

Indianapolis, Indiana

Case Study – Natural Blepharoplasty Results

Saturday, September 13th, 2014

 

Background: Aging is an inevitable consequence of living and its most recognizable effects are on the face. The first place affected on the face by aging is around and on the eyes. The near constant motion of the eyelids and its thin overlying skin are a set up for wrinkles, loose skin and bags and puffiness caused by extruding fat from under the eye. Given that the eyes more than any other facial feature reveal one’s ‘character’ and are a reported ‘mirror of the soul’,  aging changes of them reflect what most would not want others to see.

Beginning in the late 30s and early 40s, the signs of periorbital (around the eye) aging begins. Botox and other neuromuscular modulator injections do a good job of slowing down this process by decreasing the formation of crow’s feet, but it can not prevent the development of loose skin on the eyelids and the herniation of fat on the lower eyelids. These aging eye effects can be quite variable with some people more genetically prone to developing them sooner and more extensively than others. But inevitably everyone will have more of these eye aging signs than they want.

Eyelid (blepharoplasty) surgery is well known and has been around for almost a century in various forms and techniques. Most patient’s biggest fear about blepharoplasty surgery is that they will look like a different person or will look unusual or very obvious that they have had plastic surgery. They can even point to numerous celebrity examples who show exactly what they fear. How is such a result avoided? Will everyone look like they have had surgery? After all, the eyes are seen by everyone and won’t all changes be seen?

Case Study: This 58 year-old female was tired of her tired looking eyes. She wanted to look less fatigued but was afraid that she might look ‘surgical’. She had a large amount of upper eyelid skin with significant hooding. (skin laying on or near the eyelashes) Her lower eyelids show multiple redundant skin rolls and bags. Here eyebrows were not especially ptotic or has any significant sagging.

Upper and Lower Blepharoplasty result front view Dr Barry Eppley IndianapolisUnder general anesthesia, upper blepharoplasties was performed removing 12mms of skin centrally and sparing the underlying orbicularis muscle. Medial fat pockets were also removed.  Lower blepharoplasties were done using a skin-muscle flap technique. A three pocket fat removal, 5mms of tapered skin removal at the lateral canthus and a lateral orbicularis muscle suspension was done.

Upper and Lower Blepharoplasty result oblique view Dr Barry Eppley IndianapolisHer recovery took about ten days to look ‘non-surgical’ and three weeks to fairly normal. Many blepharoplasties will look a little tight for a period of time but by six weeks after surgery this has usually passed. Her results at six months show significant improvement but a result that retained her natural look.

An overdone or unnatural result from periorbital rejuvenation surgery is caused by numerous factors including aggressive tissue removal and an over elevated or exaggerated browlift. It is the browlift that is often at fault for a perceived abnormal eye look after plastic surgery. The effects of aggressive tissue removal, particularly that of fat, are often not seen until much later when the eye may look skeletonized or more hollow. The key to a natural blepharoplasty result is to not try and work out every excess bit of tissue or get rid of all wrinkles. While patients want the best result possible, they also d not want an over operated look either.

Case Highlights:

1) Aging of the eyes is the first facial area affected and is commonly treated by blepharoplasty surgery.

2) Four lid blepharoplasty (upper and lower eyelid surgery) is the most effective method of partially reversing the effects of aging on the eyes.

3) Natural blepharoplasty results occur when the amount of skin and fat removal is not overdone and lid function is not affected.

Dr. Barry Eppley

Indianapolis, Indiana

The Effect of Upper Blepharoplasty on Eyebrow Position

Thursday, June 5th, 2014

 

One of the most facial aging surgeries is that of blepharoplasty or the removal of excessive eyelid skin. It is most common because everyone develops redundant skin of the eyelids with enough age and everyone has four eyelids. Even for those patients not driven by a desire for an aesthetic improvement, an upper blepharoplasty is more common than a lower blepharoplasty because it can cause functional symptoms. The weight and hanging of excessive upper eyelid skin can push down on the lash lines, making the upper eyelids heavy and causing upper visual field impairment.

Blepharoplasty (Eyelid Tuck) Dr Barry Eppley IndianapolisBecause skin is taken away from the upper eyelid, and sometimes very aggressively to really get rid of it, the question is often asked if by doing so the eyebrow will be pulled down. Since it is common with heavy eyelids that one use their forehead muscle to lift the eyebrow and help take the weight off of the eyelids (so one can see better), does eliminating the skin reduce this habit which could also cause a drop in eyebrow position? (unmasking the real eyebrow level)

In the May 2014 issue of the Journal of Plastic, Reconstructive and Aesthetic Surgery, an article was published entitled ‘The Effect of Upper Eyelid Blepharoplasty on Eyebrow Position’. In this paper, a total of 140 consecutive patients who had upper blepharoplasty due to superior visual field obstruction were studied with before and after measurements of their eyebrow position. In addition, horizontal forehead lines were classified by degree. Their results showed that there was an average very slightdrop in eyebrow position by measurement. (less than 1.5%)  This was not visibly detectable with the exception in some men. In men, one of of six displayed a significant lowering of the eyebrow position. The sample size of men was small (14) compared to that of women. (126) Before surgery lifting of the eyebrows by means of frontalis muscle activity did not influence the position of the eyebrows after surgery, although forehead horizontal lines did seem to diminish significantly afterwards.

Male Blepharoplasty result front view Dr Barry Eppley IndianapolisTo some degree it us understandable why, in most cases, even an aggressive upper blepharoplasty does not pull the eyebrows down. Upper eyelid skin is very elastic and stretchy and allows for large resections of skin. It is not apparent at all during surgery that the position of the eyebrow moves down at all. However, it may have an eyebrow dropping effect in some men because men usually appear later for upper blepharoplasty surgery (they simply wait longer) and may have a strong and well established compensatory frontalis muscle compensation. Once their upper visual field is improved, the real natural position of their eyebrows becomes unmasked (lower) as the lifting effect of the frontalis muscle is no longer needed.

Dr. Barry Eppley

Indianapolis, Indiana

Case Study: Eyelid Lifts (Blepharoplasty) in the Older Male

Monday, February 10th, 2014

 

Background: Aging begins around the eyes early in life and continues unabated up through one’s senior years. This periorbital aging is manifested by the creation of extra eyelid skin which is caused by the stretching of the thin eyelid skin due to frequent movement. As the redundant eyelid skin becomes excessive it weighs down the upper eyelid. Known as hooding it essentially creates folds of skin that lie on the eyelashes pushing the lid margin downward.

Older Male Eyelid hooding Dr Barry Eppley IndianapolisBetween of the weight of the eyelid skin and its folding over the lashline, an obstruction of the upper visual field results. This is often not even noticed by the individual because the visual field loss is so gradual. Getting lower and lower over the years, the loss of incoming light from a gradually smaller visual field is just credited to a naturally weakening vision with age.

With this upper eyelid hooding and visual field obstruction comes accompanying forehead wrinkles. While some of these horizontal forehead wrinkles are due to lifelong facial expressions, some of them are due to a constant holding of the eyebrows upward to lift some of the skin off of the eyelids, making one able to see better. Such browlifting is often inadvertent and unnoticed by the individual.

Case Study: This 76 year-old male wanted to improve the appearance of his eyes. He said he was frequently told he looked like he was squinting all the time. He felt he looked old and that some eyelid surgery may be beneficial. He wore glasses and had no symptoms of dry eyes.

Older Male Eyelid Lift Results front view Dr Barry Eppley IndianapolisUnder general anesthesia, a large excisional skin-only upper blepharoplasty was done. No orbicularis muscle was taken. The lower eyelids were treated by the raising of skin-muscle flaps, excision of protruding fat pockets, lateral canthopexies, conservative skin removal and orbicularis muscle suspension suturing.

Older Male Eyelid Lift results oblique view Dr Barry EppleyAfter surgery he had excellent improvement in appearance of both upper and lower eyelids. He felt he could ‘see’ better and that there was more light wherever he went. He did have a minor complication of some lower eyelid irritation and lower eyelid sag at the corners which took about two months after surgery to completely resolve.

Older Male Eyelid Lift results side view Dr Barry Eppley IndianapolisBlepharoplasty (eyelid lifts) in older patients can offer great improvement in appearance and even function. But the lower eyelid must be handled very carefully as it is at high risk for after surgery lid malpositioning. (ectropion) Even when handled well (limited skin removal, tendon tighening and muscle suspension), many older patients will experience  temporary period of lower eyelid lag symptoms.

Case Highlights:

1) Advanced aging around the eyes creates severe upper eyelid hooding, upper visual field obstruction and redundant lower eyelid skin with sagging.

2) When the amount of excessive eyelid skin is considerable, the eyes can look small and one can appear to be continuously ‘squinting’.

3) Upper and lower eyelid lifts (blepharoplasties) can create considerable improvement, opening up the eyes and making them feel less heavy.

Dr. Barry Eppley

Indianapolis, Indiana


Dr. Barry EppleyDr. Barry Eppley

Dr. Barry Eppley is an extensively trained plastic and cosmetic surgeon with more than 20 years of surgical experience. He is both a licensed physician and dentist as well as double board-certified in both Plastic and Reconstructive Surgery and Oral and Maxillofacial Surgery. This training allows him to perform the most complex surgical procedures from cosmetic changes to the face and body to craniofacial surgery. Dr. Eppley has made extensive contributions to plastic surgery starting with the development of several advanced surgical techniques. He is a revered author, lecturer and educator in the field of plastic and cosmetic surgery.

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